Craniotomy

Definition

A craniotomy is a surgical procedure to open the skull. A part of the skull, called a bone flap, is removed to gain access to the brain for other procedures. In most cases, the bone flap is replaced after the procedure is finished. Craniotomies vary in size depending on what the problem is.

A craniotomy is any surgical opening into the skull, but it can also be named for the type of procedure that needs to be done, or how it is carried out. Other craniotomies types may include:

Burr hole or keyhole—a small, dime-sized hole is made in the bone of the skull

Awake—once the bone in the skull is opened, you are awakened from anesthesia

Stereotactic—computer navigation is used take images of the problem area, which then guide the surgeon to the precise location in the brain through one or more burr holes

Endoscopic—a lighted scope with a camera is inserted into the brain through one or more burr holes

Anesthesia

Local anethesia—Used for
stereotactic craniotomies. This blocks around the surgical site from pain, but you will still be awake.

General anesthesia is used to start awake craniotomies. Once the brain is exposed, the effects of anesthesia are slowly reversed. This is done so you can interact with the surgeons during the procedure. This helps them map the brain and determine which parts of the brain are critical for functioning.

Description of Procedure

Your head will be shaved and your skin will be washed with an antiseptic. An incision will be made into part of your scalp. Next, part of your skull will be removed and your brain covering will be opened. Depending on the reason for your surgery, several things may happen: a tumor may be removed, a part of your brain tissue may be taken, a tube may be placed, or repairs to your brain or its vessels may be done. The brain opening will then be sewn back into place and your skull replaced. Staples or stitches will be used to close the incision. A drain may be inserted to remove blood and fluid for the first few days after surgery. A dressing will be wrapped around your head.

How Long Will It Take?

Several hours, depending on the type and reason for surgery

How Much Will It Hurt?

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

Average Hospital Stay

The usual length of stay is 3-7 days. It is possible that you may have to stay longer if complications arise.

Post-procedure Care

At the Hospital

Right after the procedure, you will be in a recovery room where your blood pressure, pulse, breathing, and mental status will be monitored.

You may be given medications to prevent:

Pain

Infection

Blood clots

Seizures

The staff will take measures to prevent pressure build-up in your brain.

You will be asked to get out of bed and walk around to prevent complications like blood clots or
pneumonia.

At Home

When you return home, take these steps:

Continue with your physical therapist’s exercise program.

Be sure to follow your doctor's instructions.

If you feel symptoms of
depression
for more than two weeks, consider talking to a therapist or psychologist.

Call Your Doctor

Call your doctor if any of these occur:

Any changes in physical ability, including balance, strength, or movement

Any changes in mental status, including level of alertness, memory, thinking, or ability to respond

Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision

Guide to the care of the patient with craniotomy post-brain tumor resection. American Association of Neurological Nurses website. Available at:
http://www.aann.org/pdf/cpg/aanncraniotomy.pdf. Accessed December 5, 2014.

What is a craniotomy? Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/brain_tumor/treatment/surgery/craniotomy.html. Accessed December 5, 2014.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.